title: Patient education and care for peritoneal dialysis catheter placement: a quality improvement study.
abstract: OBJECTIVE
  Peritoneal dialysis catheter (PDC) complications are an important barrier to peritoneal dialysis (PD) utilization. Practice guidelines for PDC placement exist, but it is unknown if these recommendations are followed. We performed a quality improvement study to investigate this issue. ♢
  
  
  METHODS
  A prospective observational study involving 46 new patients at a regional US PD center was performed in collaboration with a nephrology fellowship program. Patients completed a questionnaire derived from the International Society for Peritoneal Dialysis (ISPD) catheter guidelines and were followed for early complications. ♢
  
  
  RESULTS
  Approximately 30% of patients reported not being evaluated for hernias, not being asked to visualize their exit site, or not receiving catheter location marking before placement. After insertion, 20% of patients reported not being given instructions for follow-up care, and 46% reported not being taught the warning signs of PDC infection. Directions to manage constipation (57%), immobilize the PDC (68%), or leave the dressing undisturbed (61%) after insertion were not consistently reported. Nearly 40% of patients reported that their PDC education was inadequate. In 41% of patients, a complication developed, with 30% of patients experiencing a catheter or exit-site problem, 11% developing infection, 13% needing PDC revision, and 11% requiring unplanned transfer to hemodialysis because of catheter-related problems. ♢
  
  
  CONCLUSIONS
  There were numerous deviations from the ISPD guidelines for PDC placement in the community. Patient satisfaction with education was suboptimal, and complications were frequent. Improving patient education and care coordination for PDC placement were identified as specific quality improvement needs.
authors.affiliation: Northwest Kidney Centers,1 and Division of Nephrology,2 University of Washington, Seattle, Washington;
authors.forename: Leslie P
authors.initials: LP
authors.lastname: Wong
authors.forename: Kalani T
authors.initials: KT
authors.lastname: Yamamoto
authors.forename: Vijay
authors.initials: V
authors.lastname: Reddy
authors.forename: Denise
authors.initials: D
authors.lastname: Cobb
authors.forename: Alice
authors.initials: A
authors.lastname: Chamberlin
authors.forename: Hien
authors.initials: H
authors.lastname: Pham
authors.forename: Sumi J
authors.initials: SJ
authors.lastname: Sun
authors.forename: Madhavi
authors.initials: M
authors.lastname: Mallareddy
authors.forename: Miguel
authors.initials: M
authors.lastname: Saldivar
mesh_terms: D000368:Aged; D002404:Catheterization; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010530:Peritoneal Dialysis / Q000295:instrumentation* / Q000592:standards*; D011446:Prospective Studies; D058996:Quality Improvement; D011795:Surveys and Questionnaires
keywords: Complications; patient education; peritoneal dialysis catheter; practice guidelines; quality improvement